Use of continuous glucose monitoring system in patients with type 2 mellitus diabetic during hemodialysis treatment

Abstract

Background: Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method: A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results: Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1±69.5 mg/dl and 173.1±78.9 mg/dl, respectively, p=0.303), in patients with body mass index less than 24.9 kg/m2 (214.2±72.2 mg/dl and 201.3±77.0 mg/dl respectively, p=0.466), in those dialysis fuid loss less than 2 l (185.5±82.6 mg/dl and 183.1±94.0 mg/dl respectively and p=0.805) and in those with hemoglobin greater than 12 g/dl (152.0±35, 5 mg/dl and 129.5±47.4 mg/dl respectively, p=0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion: The mean absolute relative diference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.